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Padala Charitable Trust (PCT)

(Educational Scholarship Program)
www.padalacharitabletrust.org
For more details: 76800 83399, 99493 97566, 98664 88681

FRESH APPLICATION FOR PCT’s SCHOLARSHIP

NOTE:
1. Please be advised that, this scholarship program is intended for poor and merit students only with
no bar on caste, religion, region or gender
2. Please post your application to Padala Charitable Trust, 7-249, Avanthi Nagar, Opp: 3rd
APSP Quarters, Thimmapuram Panchayat, Kakinada, E.G.Dist. AP- 533005 or email to
padalasurya@yahoo.com
3. Please do not send any documents along with this application. You will bring them to interview if
you are short listed.

FOR OFFICE USE ONLY DO NOT ENTER ANYTHING IN THIS BOX.

Scholar ID: Status of Application

(Created only for selected Applicants) Approved / Rejected / Hold

Scholarship Amount : Rs.

1. Applicant’s (First) Name: Surname (Last Name):

2. Male/Female: AGE: Reservation Category:

(Please note that Reservation Category is used for informational purpose only and will not affect your eligibility in any
way)
3. Date of Birth: Place of Birth: WhatsApp No:

4. Permanent Address:

PIN: Phone (Required): Email ID:

5. Address for Correspondence (if different from permanent address)

PIN: Phone: Email ID:

6. Particulars of education completed:
Class Name of educational institution & complete address %marks G/GA/P

6 to 9

Xth

Inter /Diploma

Diploma
Bachelor Deg

NOTE: G-Govt. School/College; GA-Govt.Aided School/College; P-Private School/College

7. Details of course currently studying:

a) Name of the course joining/joined:
b) Rank secured in the entrance test if any:
c) Name & Address of the Institution admitted in/applied to:
 e) Is it a Govt./Govt. Aided/Private Institute :
f) Tuition fee paid/payable per annum:
8. Details of family members:

Member Name Age Education Occupation Income p.a

in Rs.

Father

Mother

Brother/ Sister

Brother/ Sister

9. Details of ASSETS in the family i) Land (Extent & value):

ii) Do you have Own House / Building / Shop: Yes/No If Yes, Rental Income per month:

10. Particulars of financial support you are receiving from the following sources:

Source Amount in Rs. Per annum

Merit Scholarship (s) :

Caste / Community Scholarships from Govt :

Other Trusts / Organizations / Individuals :

11. Estimated expenditure on the course study per annum:
a) Amount in Rs.:

b) Indicate below how the total expenditure is proposed to be met: (attach any receipts from the
institution/college)

12. Mention anything important that you want PCT to know about you and your family:

I affirm that the above information is true. I also pledge that on completion of my education and getting
employment, I shall support financially the education of at least two bright and poor students.

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(Name of the Applicant) (Signature of the Applicant)

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Place Date

I vouch for the information provided in this application by my son/ daughter/ ward.

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(Name of the parent/guardian) (Signature of the parent/guardian)

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Place Date